One of the strongest objections to the development and use of substantially life-extending interventions is that they would exacerbate existing unjust disparities of healthy lifespans between rich and poor members of society. In both popular opinion and ethical theory, this consequence is sometimes thought to justify a ban on life-prolonging technologies. However, the practical and ethical drawbacks of banning receive little attention, and the viability of alternative policies is seldom considered. Moreover, where ethicists do propose alternatives, there is scant effort (...) to consider their merits in light of developing world priorities. In response to these shortcomings, I distinguish four policy options and, on the basis of a plausible intuition about fairness, evaluate their implications for a fair distribution of healthy lifespans. I claim that even in developing nations it would be fairest to favor policies that promote equal access to at least one promising category of substantially life-extending intervention: calorie restriction mimetics. (shrink)

Prioritarianism pertains to the generic idea that it matters more to benefit people, the worse off they are, and while prioritarianism is not uncontroversial, it is considered a generally plausible and widely shared distributive principle often applied to healthcare prioritisation. In this paper, I identify social justice prioritarianism, severity prioritarianism and age-weighted prioritarianism as three different interpretations of the general prioritarian idea and discuss them in light of the effect of pandemic consequences on healthcare priority setting. On this analysis, the (...) paper arrives at the following three conclusions: that we have strong prioritarian reasons for special concern about the vulnerable and socially disadvantaged in reference to pandemic effects, that severity of illness is an important factor in identifying the worse off in priority setting but that this must not over-ride the special priority to the socially disadvantaged and that the maximisation rationale of the age-weighted view runs against the core prioritarian idea, and the age-weighted prioritarianism is thus unfitting as a prioritarian response to the COVID-19 case. (shrink)

Wenn eine Person unter einer tödlichen Krankheit leidet und nicht über die Ressourcen für eine medizinische Behandlung verfügt, sind wir normalerweise dazu verpflichtet, ihr die notwendigen Ressourcen bereitzustellen. Wären wir aber in einem biotechnischen Zukunftsszenario, in dem die menschliche Lebensspanne durch Eingriffe in den Alterungsprozess erhöht werden kann, auch dazu verpflichtet, anderen Personen die notwendigen Ressourcen für solche Maßnahmen bereitzustellen? John Harris hat argumentiert, dass wir zu solch einer direkten biotechnischen Lebensverlängerung verpflichtet wären, da ein Leben zu verlängern das Gleiche (...) sei, wie ein Leben zu retten. Im vorliegenden Aufsatz wird gezeigt, dass Harris’ Argument nicht schlüssig ist, da entgegen seiner Prämisse ein begrifflicher Unterschied zwischen der Rettung und der Verlängerung eines Lebens besteht. Auf Grundlage von Harris’ zurückgewiesenem Argument werden dann aber zwei alternative Argumente für eine (prima facie) Pflicht zur direkten Lebensverlängerung konstruiert. Das erste Argument basiert auf der Überlegung, dass durch eine direkte biotechnische Lebensverlängerung trotz des begrifflichen Unterschieds mit einer substanziellen Wahrscheinlichkeit Leben gerettet werden würden. Das zweite Argument besagt, dass trotz deskriptiver Unterschiede eine moralische Äquivalenz zwischen der Rettung und der Verlängerung eines Lebens besteht, sofern durch die bloße Lebensverlängerung das Leben um die gleiche Dauer und Qualität verlängert wird wie durch die Lebensrettung. ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- When a person suffers from a deadly disease and is lacking the resources for a medical treatment, we are normally obliged to provide the necessary resources. But would we also be morally obliged to provide the resources for an extension of someone’s lifespan through anti-aging treatments which might be developed due to biotechnological progress? John Harris has argued that there would be an obligation to such a direct biotechnical life extension because extending a life is the same as saving a life. In the present paper, it will be shown that Harris’ argument is not sound since, contrary to his premise, there is a conceptual difference between extending and saving a life. On the basis of Harris’ rejected argument, though, two alternative arguments for a (prima facie) obligation to direct biotechnical life extension will be developed. The first argument is based on the idea that, despite the conceptual difference, one saves someone’s life with a substantial probability when extending it by direct biotechnical means. In the second argument, it will be argued that there is a moral equivalence between extending and saving someone’s life despite the descriptive differences as far as the additional lifetime has the same duration and quality in both cases. (shrink)

In the recent literature across philosophy, medicine and public health policy, many influential arguments have been put forward to support the use of randomization procedures to allocate scarce life-saving resources. In this paper, I provide a systematic categorization and a critical evaluation of these arguments. I shall argue that those arguments justify using RAND to allocate SLSR in fewer cases than their proponents maintain and that the relevant decision-makers should typically allocate SLSR directly to the individuals with the strongest claims (...) to these resources rather than use RAND to allocate such resources. (shrink)

Ageism is the view that it is of greater moral value to allocate health care resources to younger people than to older people. In medical ethics, it is well-known that standard interpretations of distributive principles such as utilitarianism and egalitarianism imply some form of ageism. At times, ethicists argue as if practical complications are the only or main reason for not abiding to ageism. In this article, we argue that inferences to ageism from such distributive principles tend to commit what (...) we call the anticipation-blindness fallacy: A much too narrow focus on life quality benefits of health care treatments inclines us to overlook the importance of life quality benefits of health care safety, that is the mere trust in and expectation of being treated and cared for as one grows old. This is a key omission because health safety has value for a much larger population and for much longer time. Taking health safety into account therefore has important implications as for how ageist we ought to be. (shrink)

Age-based rationing remains highly controversial. This question has been paramount during the Covid-19 pandemic. Analyzing the practices, proposals, and guidelines applied or put forward during the current pandemic, three kinds of age-based rationing are identified: an age-based cut-off, age as a tiebreaker, and indirect age rationing, where age matters to the extent that it affects prognosis. Where age is allowed to play a role in terms of who gets treated, it is justified either because this is believed to maximize benefits (...) from scarce resources or because it is believed to be in accordance with the value of fairness understood as (a) fair innings, where less priority is given to those who have lived a full life or (b) an egalitarian concern for the worse off. By critically assessing prominent frameworks and practices for pandemic rationing, this article considers the balance the three kinds of age-based rationing strike between maximizing benefits and fairness. It evaluates whether elements in the proposals are, in fact, contrary to the justifications of these measures. Such shortcomings are highlighted, and it is proposed to adjust prominent proposals to care for the worse off more appropriately and better consider whether the acquired benefits befalls the young or the old. (shrink)